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Lecture notes, cheat sheets
История медицины. Здравоохранение и развитие медицинской науки в советский период (1917-1991 гг.) (конспект лекций)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 9. Health care and the development of medical science in the Soviet period (1917-1991) 1. General historical characteristics of the period under review It is very difficult to give a clear framework and brief characteristics of such a long and difficult period in the development of Russia, because the Soviet period, which covered the time from 1917 to 1991. rich in various fateful events: the Great October Revolution of 1917, the period of the formation of the new Russia (1917-1920), accompanied by the Civil War and intervention, the split into "reds" and "whites", the NEP period, the formation of the USSR and the leading communist parties, the collectivization of the peasantry, the long rule of Stalin, which led to many irreparable consequences, the pre-war period and the years of the Great Patriotic War, constant changes in government, especially the last two decades of the existence of the USSR, and, finally, its collapse. All these events were experienced by the Russian people, people lived in constantly changing conditions. The beginning of the Soviet period - October 1917 - was marked by a revolution and the establishment of Soviet power in the center and in the regions. In the capitals, the approval of the new government was difficult, with obstacles and a constant change in the composition of the people at the head of this process. The coup took place in 2 stages: 1) February Revolution (February 23 - March 3, 1917); 2) October Revolution. In October, the Bolsheviks finally seized power, so the concept of the "Great October Revolution" combines both of these events, which are a continuation of each other. In February, it became clear that Russia was faced with a choice of ways to overcome the crisis, which became the logical consequence of the revolution: either it was necessary to pursue a democratic policy and its acceleration and thereby stabilize society, or to stabilize it against the backdrop of a brutal dictatorship, turn, could only lead to an aggravation of the social split, and consequently, both political and social forces. Two types of dictatorship were foreseen, one of which was to take root as a result - right-wing conservative and left-wing radical. The alternative to hard dictatorship has won. In October, events began that had a certain impact on the whole world, and in Russia radically changed the socio-economic, political and cultural traditions. The Bolsheviks, who seized power, announced the accomplishment of the Great Socialist Revolution. The formation of a new government was accompanied by a brutal Civil War. Its origins were the street battles of 1917, which were the result of a split in society into supporters and opponents of the revolution. Formally, its beginning was marked by the removal of the Provisional Government. The height of the war fell on 1918, when the forces of the opposing sides became practically equal, and the confrontation of the people turned into the category of fratricide. This period ended when the White Front was liquidated in the Crimea in 1920. Finally, the Civil War was completed in 1922, in the autumn, with the expulsion of Japanese military units from the Russian Far East. A special feature of the "Citizen", as it was called, was its interweaving with the anti-Soviet intervention of the Entente countries. This period was a terrible time in the history of Russia: the total damage to the national economy was more than 50 million gold rubles; compared to 1913, in 1920 industrial production decreased by 7 times, and agricultural production by almost 2 times. The number of the working class was almost halved: some returned to the villages, some settled in the bureaucratic strata, some died at the fronts. Those who remained did odd jobs. Partly in connection with this, partly for other reasons, the revolutionary class consciousness of the people became dulled. This was dangerous for the authorities because among the village residents, the majority of small owners, the number of which increased in connection with the earlier agrarian reform, were always wary of the Bolshevik power. Among the peasants, middle peasants began to predominate, as well as rural farm laborers and the poor. More than 8 million people died from epidemics, famine, and battles; 2 million, who made up the political, financial and scientific elite, emigrated. But the most terrible consequence was that the belief in the superiority of violence and the possibility of neglecting human life - this is the name of achieving bright ideals - took root in people's minds. The Bolsheviks won then, but the support that fed them from the people was more than conditional, because people chose their lesser two evils. At that time, the statehood and sovereignty of Russia was preserved, but the limited nature of the recognition of Bolshevik power threatened with new terrible upheavals. Then came the period of the NEP (March 1921), accompanied by ups and downs in the economy due to unforeseen contradictions in the NEP policy. In 1925, the Communist Party proclaimed a course towards industrialization, the initial stage of which fell on 1926-1928. Since October 1917, the Bolsheviks tried to subdue the Russian Orthodox Church, which gradually began to give up its anti-Bolshevik positions. In 1927, a "Declaration" was signed, in which a demand was made for clergymen who did not accept the new ways to step back from their duties, which naturally caused a new wave of indignation in the ranks of believers. The Bolsheviks also paid great attention to culture, having carried out a cultural revolution, which mainly concerned the eradication of the views of the old intelligentsia and the formation of the Soviet intelligentsia, which would faithfully serve the new government and be loyal to the regime. Reformation was also carried out in the field of education, a new public Soviet school was founded, in which much attention was paid to the formation in students of a "class approach" to assessing everything that is happening, as well as the past. On December 30, 1922, the declaration "Treaty on the Formation of the Union of Soviet Socialist Republics" was adopted, and a union government was formed - the Council of People's Commissars. From that moment on, there was an intensive development of the one-party system in the USSR. In 1932, the first five-year plan for the development of the national economy of the USSR, or the first five-year plan, was adopted. Since that moment, the country has become a huge construction site. At the same time, a system of card distribution of consumer goods was introduced. A milestone that left a mark on history was the collectivization of the peasantry and the spread of dispossession. January 5, 1930 is considered the beginning of this event. In 1935, a new version of the agricultural artel was already adopted. The result of collectivization was a famine in the country, to overcome which then a lot of effort was put. In the 1930s The main foreign policy direction of the USSR was relations with Germany. The influence of fascism was already felt in Europe. Stalin pursued a cautious dual policy towards Germany and Japan. These two states most of all posed a danger to the USSR at that moment. In 1939, a "Non-Aggression Pact" was signed between Germany and Russia. However, Hitler, who had captured almost all of Europe by 1940, by the beginning of 1941 had a detailed Barbarossa Plan to attack the USSR. So, on June 22, 1941, the Great Patriotic War began, which lasted until May 1945. A long, exhausting war claimed millions of lives of both the Soviet people and enemy troops. Until December 1941, the offensive of the German troops was little reflected by the Russians. The German army was huge, since it included not only Germans, but also people from previously captured states: Italians, French. That is why the Great Patriotic War was one of the important stages of the Second World War, and its outcome had to decide a lot not only in Russia, but throughout the world. In December 1941, Soviet troops launched a powerful counteroffensive near Moscow, and in January 1942, the United Nations Declaration on the Joint Fight against Fascist Aggression was signed in Washington. Russia had a more clearly defined hope for victory. But until the end of the summer of 1942, the Russian army was waiting for failure. Only on November 19, 1942, a radical turning point occurred in the course of the war. Back in the summer, Donbass was occupied, Sevastopol fell, and the assault on Stalingrad began. And on February 2, 1943, the remnants of the group that kept Stalingrad surrounded, consisting of 330 thousand soldiers, surrendered. On July 5, 1943, the Wehrmacht attacked the Kursk Bulge, and the Battle of Kursk did not stop until August. After these two grandiose victories, something broke in the work of the German military machine. In 1944, the Leningrad blockade was finally broken, which began at the very beginning of the war and lasted 900 days. Then, one by one, the largest cities were liberated from the Germans. The first and second Ukrainian fronts broke through to the border with Romania, later, under the command of the troops of Marshal Rokossovsky, Belarus was liberated, later Moldova, Transcarpathian Ukraine and the Baltic states. Thus, the state border of the USSR from the Barents to the Black Sea was restored. Tangible support was then provided by the troops of England and the United States, which, having landed in the north of France, liberated it from the western occupation of the fascist troops. Their path lay in Berlin. All of 1944 and early 1945. The Red Army marched across the Union in a wave of victories and liberations. By April 1945, the capital of the Third Reich was blocked by soldiers of the Soviet army. On April 30, the red banner of Victory fluttered over the defeated Reichstag. In just a few days, Budapest, Koenigsberg, Vienna, Prague and other major cities and world capitals were liberated. On May 9, 1945, an act of unconditional surrender of Germany was signed with representatives of the German command. It was Victory Day. The USSR summed up the decisive result of the entire Second World War: it was the deliverance of the world from fascist enslavement that seriously threatened it. The Soviet-German front was the main one in the entire war. Both sides lost most of their soldiers and weapons here. The damage to the USSR was colossal - about a third of the national wealth. But these losses cannot be compared with human losses: 27 million people died on the fronts of the Great Patriotic War. As offensive as it may be, these losses were not only the result of the great power of the fascist troops, but also the result of the disregard for human lives of the Soviet leaders. History has not seen such a number of ill-conceived and technically unsupported offensives as during the war. And one of the main results of the war was the growing opposition of the capitalist countries to the Soviet Union. This confrontation largely predetermined the fate of the Soviet Union. In addition, it began in the atomic era, which also had its significance, because immediately after the victory over Germany, the world began to balance on the brink of a third World nuclear war. Moreover, the threat to Russia came primarily from the recently friendly United States. The last years of Stalin's rule passed under the sign of the Cold War: the USSR tried to transfer all of Europe to the Soviet regime, and Europe, in turn, united with the United States, tried to eradicate Soviet power even in Russia and achieve the dominance of capitalism. At the same time, the United States, under the presidency of Truman, declared that they were a contender for world domination. Any threats were used up to the use of atomic weapons against Russia. Its first tests were already carried out in 1945. Then two atomic bombs were dropped on the Japanese cities of Hiroshima and Nagasaki. There was a lot of controversy about the use of nuclear weapons, there were proposals from both the United States and the USSR. The parties did not yield to each other. The success of the USSR in this struggle was that, starting from 1944, the "socialist camp" was actively formed by establishing a communist regime in Hungary, Czechoslovakia, Bulgaria, Yugoslavia, Albania, Poland, Romania and other countries. The situation was especially with Germany, from which one could expect anything. In 1949, the Federal Republic of Germany was organized and its constitution adopted. A few months later, the USSR formed a second state - the German Democratic Republic. It was on the territory of those lands that were occupied by the Soviet army. Established in 1945, the United Nations became a tribune where world issues were resolved quite fiercely. It was originally created to suppress the voice of the USSR. However, the protection of the right of veto in the Security Council by representatives of the Soviet government made it possible for the USSR to further actively express its opinion in defense of the sovereignty of small states or "third world countries", where Stalin tried to strengthen the position of communism. Nevertheless, no matter how much the question of establishing the world domination of one of the regimes was raised, it remained “frozen”: either because of the lack of arguments in defense of the parties, or from an overabundance of them and an understanding of the futility of the struggle. Nevertheless, Stalin's main task was to resurrect the country from the ashes and prevent the emergence of undesirable moods among the people, in connection with which people who represented a "danger to society", namely those who returned from German concentration camps and captivity, were isolated from the public. May 5, 1953 JV Stalin died. Power was concentrated in the hands of his successors G. M. Malenkov, L. P. Beria and N. S. Khrushchev. The fight developed rapidly. In June 1953, L.P. Beria was arrested for conspiracy with imperialist intelligence services, and later L.P. Beria was shot; in 1955, Malenkov retired. So, from September 1953, N. S. Khrushchev became the first secretary of the CPSU Central Committee. He was engaged in the liquidation of "Stalinism" in the USSR, carried out various reforms, raising Russia economically, and gave Crimea to Ukraine. The most memorable event that occurred during his reign and related to foreign policy was overcoming the Caribbean crisis, when the whole world watched the actions of D. Kennedy, F. Castro and N. S. Khrushchev in Cuba, balancing on the brink of nuclear war. By the end of Khrushchev's leadership in the USSR, the country was brought out of the stupor of the past era and raised from its knees. However, this time was remembered by "personnel leapfrog", an attempt to introduce a "leveling" between high government officials and ordinary people; many thousands of officers were left without salaries, peasants and workers were tired of fighting for a "bright future", while the future was getting worse. Therefore, in 1964, Khrushchev was removed from all posts, accused of "voluntarism and subjectivism," and L. I. Brezhnev became the first secretary of the Central Committee, and A. N. Kosygin became chairman of the Council of Ministers. L. I. Brezhnev served as General Secretary until 1982. Russia followed the path of development of a directive economy, but, despite all the steps taken, it lagged far behind the countries of Western Europe. Even the development of such industries as cosmonautics and the military industry was limited by technical capabilities. The "advantages of developed socialism" over already "decaying capitalism" were promoted in every possible way. It was in connection with this that the new Constitution of the USSR was adopted in 1977, the preamble of which stated the fact that a "developed socialist society" had been built, although this was far from the case, and, moreover, the building of socialism regressed rather than progressed. . In 1982, Brezhnev's place was successively occupied by Yu. V. Andropov, and after his death in 1984, by K. U. Chernenko. He died in 1985. And his post was taken by MS Gorbachev. The post of chairman of the Council of Ministers of the USSR was taken by N. I. Ryzhkov. From that moment began the last stage in the history of the USSR - "perestroika": at the head of all tasks and plans was the prevention of the collapse of "state socialism" through the implementation of cautious, "soft" reforms, mainly related to the economic sphere of the union. In April 1985, the government proclaimed a direction to accelerate socio-economic development. However, the lack of the necessary equipment led to an increase in the number of accidents at enterprises, the largest of which was the accident at the Chernobyl nuclear power plant (April 1986). The country introduced a "dry law" and the principle of combating "unearned income". In the summer of 1987, the rights of enterprises were expanded, and in the summer of 1988, a number of laws were adopted that opened the way to private property. At the same time, the "shadow economy" began to develop with the laundering of a huge amount of money. In 1990, a resolution "on the concept of transition to a regulated market economy" was adopted, which provided for demonopolization and decentralization, the establishment of banks and joint-stock companies. There was a gap in the mechanism of reforming the credit system and pricing policy, which further led to the impossibility of the final implementation of plans, the half-heartedness of results. In 1988, not without fear, the government decided to undertake radical political reform. Censorship was relaxed, and people were given hitherto unknown freedom of action and voice. This soon entailed the spread of previously banned literature, films, programs, etc. People began to understand the conditions in which they lived, and many opponents of the Soviet regime appeared who were no longer afraid to make themselves known. The number of party members in the country dropped from 21 to 15 million people over the course of several months. Soon, other republics that were part of the Union realized that better development could only be achieved if they left the Soviet Union. The Baltic republics, and after them the Russian Federation, declared the superiority in power of their laws over the laws of the USSR. A new government position was introduced - the President of the USSR, which was occupied by M. S. Gorbachev, after which he had to enter into negotiations with the leaders of the republics. The negotiations were to be devoted to concluding a new Union Treaty. It was not supported, and after some time a compromise agreement was presented, granting much more rights to individual states and reducing the importance of the center in governing the Union. However, the signing of the agreement never happened. On August 19, when Gorbachev was vacationing in Crimea, the State Committee for the State of Emergency was established. It was announced that the government structures had been disbanded and the party's activities had been stopped. The country froze in anticipation. Only the President of the RSFSR, B. N. Yeltsin, who was elected by popular vote in June 1991, managed to organize a “path”, which, however, was not of particular national importance. On August 22, members of the State Emergency Committee were arrested on charges of attempting a coup. Immediately after that, the activities of the CPSU on the territory of the Russian Federation were banned. The Baltic republics hastened to secede from the Union. Gorbachev tried to fight for the Union Treaty in order to prevent the uncontrolled disintegration of the Union and irreversible disasters for millions and millions of compatriots. These actions were useless. December 8, 1991 B. N. Yeltsin, L. M. Kravchuk and S. S. Shushkevich announced the dissolution of the USSR. Soon the Commonwealth of Independent States (CIS) was created. It was the famous "Belovezhskaya agreement". On December 21, 8 more states joined the CIS, and on December 25, MS Gorbachev resigned. Thus the Union of Soviet Socialist Republics ceased to exist. 2. The formation of Soviet medicine The historical events of 1917 brought ruin not only to the political and economic spheres of life. They affected the life of the population, and, of course, the general state of people's health. At the beginning of the Soviet period, with the coming to power of the Bolsheviks and the establishment of a new regime, a wave of epidemics of cholera, typhus, smallpox and other diseases swept the country. The situation was aggravated by the widespread shortage of qualified personnel, equipment and medical equipment, and medicines. There were very few hospitals, preventive medical institutions. The civil war left a deep mark in history, bringing with it devastation in the industrial activity of the country, agriculture. A wave of hunger swept across the country. In agriculture, there was not only enough seed, but also fuel for agricultural machinery. Communication between settlements was reduced to a minimum, there was not enough water even for cooking and quenching thirst, not to mention other household needs. Cities and countryside literally "overgrown with mud", and this already served as a threat of epidemics. HG Wells, who visited the Union in 1920, was shocked by what he saw compared to what he had seen 6 years earlier. It was a picture of complete collapse, the country that appeared to his eyes was the wreckage of a great empire, a huge shattered monarchy, fallen under the yoke of cruel senseless wars. At that time, the death rate increased 3 times, the birth rate halved. Only an organized healthcare system could save the country from extinction, help in the fight against diseases and epidemics. Such a system began to actively form in 1918. To create a developed structure that could effectively serve all segments of the population, it was necessary to combine all types of departmental medicine under a single state control: zemstvo, city, insurance, railway and other forms. Thus, the formation of a unified health care system attracted more and more people and was of a "collective nature" - they literally recruited from the world one by one. This "gathering" of medicine took place in several stages. The first phase fell on October 26, 1917, when the Medical and Sanitary Department was formed. It was created under the Military Revolutionary Committee of the Petrograd Soviet of Workers' and Soldiers' Deputies, headed by M. I. Barsukov. The main task of the department was to unite and involve in the work of all doctors who recognized the new government; it was also necessary to radically change the medical and sanitary business in the country and organize qualified assistance to workers in enterprises and soldiers in the active troops, as well as those in reserve. Since the reform had to be carried out everywhere in order to cover more area, medical and sanitary departments and medical colleges began to be created locally. The tasks facing the latter were of a public nature, so on January 24, 1918, the Council of People's Commissars signed a decree establishing the Council of Medical Colleges. This council became the highest medical body of the workers' and peasants' government. A. N. Vinokurov became the head of the body, V. M. Bonch-Bruevich (Velichkina) and I. M. Barsukova were appointed his deputies. In order for the people to know about the active work of the Council, on May 15, 1918, the first issue of the News of Soviet Medicine was published under the Council of People's Commissars of the RSFSR. It was the first Russian medical public publication, which then appeared regularly. The Council of Medical Colleges saw its main task in fulfilling the following conditions: continuing the widespread organization of medical and sanitary departments, consolidating the initiated reforms regarding the transformation of military medicine, strengthening, developing sanitary affairs and strengthening epidemic control throughout the country. However, in order to act on the scale of the whole country and objectively monitor the results of the work carried out, it was necessary to hold the All-Russian Congress of Representatives of the Medical and Sanitary Departments of the Soviets. The congress was held on June 16-19, 1918. It raised not only the organization and work of the People's Commissariat of Health, which were the most important at that time, but also questions of insurance medicine, the question of combating epidemics, and questions about the tasks of local medicine. The result of the work of the congress was the adoption of a decision on the creation of the People's Commissariat of Health, which was to become the main body of health and be in charge of all medical and sanitary affairs. On June 26, 1918, a project for the creation of the People's Commissariat of Health was presented. On July 9, the draft was also published for the general public, and on July 11, the Council of People's Commissars signed a decree "On the Establishment of the People's Commissariat of Health." The first collegium of the People's Commissariat of Health of the RSFSR was created, in which V. M. Velichkina (Bonch-Bruevich), R. P. Golubkov, E. P. Pervukhin, Z. P. Solovyov, P. G. Dauge were appointed, and the first commissioner of health was appointed N. A. Semashko. Z. N. Solovyov became his first deputy. In July 3, the People's Commissariat of Health was renamed the People's Commissariat of Health of the USSR by decree of the All-Russian Central Executive Committee and the Council of People's Commissars. G. N. Kaminsky became its first head. N. A. Semashko Nikolai Alexandrovich Semashko (1874-1949) made a huge contribution to the development of not only Soviet, but also world medicine. Semashko's career did not start with brilliant success: he graduated from Kazan University, after which he worked for 3 years as a zemstvo doctor in the Oryol province, and then in Nizhny Novgorod. The revolution in February 1905 ended for him with arrest, imprisonment for 10 months, and then 10 years of emigration in France, Switzerland and Serbia. In the summer of 1917, at the age of 43, he returned to Moscow with a group of other emigrants. He took part in the medical arrangement of the country from the moment the idea of creating a state healthcare system arose: first he headed the medical and sanitary department of the Moscow Council, and later became the first People's Commissar of Health of the RSFSR. He managed the People's Commissariat for Health for 11 years, in the most difficult years for the country, when there was a bloody Civil War, epidemics raged in the Union. He also took part in the development of anti-epidemic programs, seriously stated the need to create a program for the protection of motherhood and childhood and the need to develop Soviet medicine by improving and expanding the network of research institutes. Under him, sanitary-resort business began to develop intensively, the system of higher medical education was transformed. N. A. Semashko made a huge contribution to the development of hygiene in the USSR, opening in 1922 the Department of Social Hygiene at the Medical Faculty of Moscow State University. He himself was the head of this department for 27 years. In 1927-1936. the first edition of the Great Medical Encyclopedia was created and published, the initiator of which was N. A. Semashko. From 1926 to 1936 he headed the children's commission of the All-Russian Central Executive Committee. He put a lot of effort into studying the sanitary and hygienic situation after the war. N. A. Semashko became one of the founders and one of the first academicians and members of the Presidium of the USSR Academy of Medical Sciences. He was director of the Academy of Pedagogical Sciences from 1945 to 1949. Since 1945, he held the title of Academician of the Academy of Pedagogical Sciences of the RSFSR. He also became the founder of the Institute for the Organization of Public Health and the History of Medicine of the USSR Academy of Medical Sciences, after its creation he led it from 1947 to 1949. This institute bore his name for a long time, later it was renamed the National Research Institute of Public Health of the Russian Academy of Medical Sciences. Nikolai Alexandrovich Semashko, despite the great responsibility that lies on his shoulders and the large number of positions he holds, managed to leave his mark on the development of physical culture and sports, as he became the first chairman of the organization in charge of this area of medicine, and also headed the board of the All-Union hygienic society (1940-1949). Throughout his life, he wrote scientific works and works, of which there are more than 250. All of them were devoted to theoretical, organizational and practical issues of hygiene and health care in general, which earned him immortal memory among the people. 3. P. Solovyov Zinovy Petrovich Solovyov (1876-1928), in addition to his high positions in the health sector, is known for the fact that in 1925 he initiated the creation of the All-Union Pioneer Camp "Artek" on the Black Sea coast, which exists to this day. He left behind many scientific works in which he raised questions and actively developed programs to overcome difficulties in the development of medical science and higher medical education in the USSR. G. N. Kaminsky Grigory Naumovich Kaminsky (1895-1938), before being appointed the first People's Commissar of Health of the USSR, served for 2 years as People's Commissar of Health of the RSFSR (1934-1935) and the USSR (1935-1937). He was the organizer of the All-Union State Sanitary Inspectorate. In 1935, based on his developments, a program was adopted to improve medical care and services for the city and rural population. He contributed to the transfer of the chemical and pharmaceutical industry to the department of the People's Commissariat of Health of the RSFSR. He left a deep mark in the development of medicine as a science and in medical education, he also became one of the organizers of VNEM in Moscow and Leningrad. Special thanks to G. N. Kamensky could be rendered for assistance in organizing the first international congresses. However, his activity in the state field was short-lived, the period of his active work was only 4 years, since on June 25, 1937 he was arrested and shot, after he spoke at the Plenum of the Central Committee of the All-Union Communist Party of Bolsheviks with a condemning speech against the policy of repression, many of his comrades-in-arms were arrested and shot with him. Later they were all posthumously rehabilitated. 3. Principles of medicine in the USSR. Higher medical education Four basic principles predominated in the then organized health care system. First, medicine was supposed to be of a state nature. Secondly, medicine should have a preventive direction. Thirdly, medicine had to involve the population for active participation in the protection of public health. Fourthly, medicine had to propagate the need for the unity of scientific medicine and public health preventive measures. In principle, the ideas were not new, because they began to be formulated even before 1917. Even S. P. Botkin, G. E. Rein and their older colleagues - Johann Peter Frank, Hippocrates and other scientists - had already predicted that the future belongs to a preventive (preventive) medicine. But it was only in the era of the beginning of the Soviet period that all these principles could be combined into clear tasks and implemented. The most important principle of Soviet medicine was the need to give it a state character. To do this, it was necessary to bring it under a single center of management, state financing, and also to ensure the direct participation of the highest state authorities in the preparation and approval of public health programs. Medicine had to acquire two new qualities - free and generally accessible. Previously, such principles of medical care were not practiced. The result in the creation of a well-coordinated healthcare system was the approval of the People's Commissariat of Health. This was in 1918. A little later, the "Decree on the People's Commissariat of Health" was issued, in which the centralized management of the health care system was already clearly fixed. It was then that benefits for medical care were introduced, the network of medical and preventive institutions was expanded, which, first of all, became available to workers in hazardous enterprises, trade union members, the disabled, and Red Army soldiers; all this made medicine accessible to the general population, it became common for people to turn to a polyclinic doctor in case of malaise, whereas earlier, under similar conditions, people often died from the fact that even the initial manifestations of the disease due to the lack of medical care could turn into severe disease. The second principle of Soviet medicine - the preventive direction - has achieved, perhaps, the most significant success. Various bodies were established to oversee the sanitary and hygienic situation in the country: a unified state sanitary service, a system of sanitary and epidemiological stations, etc. Finally, it was realized that the severe epidemic situation in the country does not lie in some global causes, but in the absence of elementary working conditions, poor nutrition at enterprises and, as a result, the deterioration of life due to lack of time and money for workers. The situation began to be actively corrected, and constant sanitary control was introduced not only at enterprises, but also in the private life of people: constant home visits to sanitary doctors urged people to comply with sanitary and hygienic standards, because medical workers had the right to go to court for violation of them which had dire consequences. Then for the first time they started talking about the need for the complete elimination of individual infectious and viral diseases. The People's Commissariat of Health and the Council of People's Commissars allocated huge sums of money for the implementation of these plans. The results were not long in coming: soon such contagious diseases as plague, cholera, smallpox were eliminated throughout the Union. The measures were so effective that not only in peacetime, but also during the Great Patriotic War, there were no cases of epidemics, which until then was unheard of. Already after the war, anti-epidemic measures also led to the elimination or reduction of the number of such diseases as typhus (relapsing, typhoid, typhus), paratyphoid, and malaria. People began to get sick with acute intestinal infections much less. All this had a lot of positive aspects, but there were also disadvantages: since special attention was paid specifically to infectious diseases, in the near future the country had to face the problem of increased incidence of diseases of the cardiovascular system among people, and also came to the fore oncological diseases. Immediately the question arose about the retraining of sanitary-resort institutions and the necessary medical examination of the entire population of the country. The involvement of the workers themselves, the intelligentsia and the peasants themselves in the measures for health care became simply necessary, especially during the years of the Civil War and intervention. The problem was that medicine had lost its professionalism due to an acute shortage of qualified personnel. The fact is that most doctors of that time did not share the principles of the new form of government: many of them emigrated, many declared sabotage, many died on the fronts and in the fight against epidemics. The population remained on mutual medical assistance: people themselves began to organize sanitary detachments at enterprises and promoted a healthy lifestyle. Various wall newspapers and publications were published, the most famous of which was "Windows of ROSTA", in the creation of which V. V. Mayakovsky took part. After the relative stabilization of the situation, the government began to pay the most attention to the development of higher medical education and the training of qualified personnel. Only a few years later, when the ranks of qualified medical workers were replenished, medicine returned to the mainstream of professionalism, and the participation of the general population in public medical education ceased to be a necessity. At that time, it was necessary to work on the unification of practical activities in the field of health and medical science. As a science, medicine was going through a difficult period: due to the general devastation, doctors-scientists were cut off from the whole world, deprived of the opportunity to study foreign medical literature, to conduct scientific discussions with colleagues from other countries. There was a severe shortage of equipment in the laboratories. There were no normal working conditions - the laboratories were not heated, they had no electricity. However, in spite of everything, scientists continued to carry out experimental work, moreover, of world significance. The great representatives of Russian medicine: V. M. Bekhterev, A. A. Kisel, N. I. Burdenko, E. N. Pavlovsky, I. P. Pavlov continued to work on the same enthusiasm, starving and suffering hardships. It was at that time that compulsory vaccination against certain diseases was introduced, effective methods of combating tuberculosis were invented, poliomyelitis was eliminated, and the mechanisms of transmission of many transmissible diseases were discovered. Throughout the country, despite the difficult economic and political situation, a mass organization of scientific research institutes and laboratories of national importance was carried out. In 1918, the Scientific Medical Council was established, which was engaged in the development of higher medical education, forensic medical examination, the compilation of the state pharmacopoeia, and many other issues. With the active participation of the council, the State Institute of Public Health was opened, which included 8 research institutes dealing with issues of sanitary and hygienic conditions, tropical diseases, microbiology, etc. Throughout Russia from 1918 to 1927. more than 40 research institutes were opened, among which was the Saratov Institute of Microbiology and Epidemiology (1918). Science and practice merged together, because new scientific discoveries were immediately introduced into practical use, and observation and the fight against mass diseases helped to create new scientific principles and tasks. In the field of higher medical education, an innovation was that since 1930 all the medical faculties of the country separated and became medical institutes, of which there were 1935 throughout the country by 55. They included pharmaceutical, pediatric, dental faculties, which contributed to the formation of the first medical universities, as well as residency in clinical departments and postgraduate studies. A similar development of the healthcare system in the USSR could serve as an example for many other countries (Great Britain, Cuba, China, etc.). 4. Medicine during the Great Patriotic War. The development of medicine in the post-war period From 1941 to 1945 The Great Patriotic War was going on, which became the bloodiest in the entire history of mankind. More than 27 million soldiers and civilians died. But many survived and survived thanks to the actions of Soviet military doctors. The initial period of the war was especially difficult in terms of medical support: there were not enough personnel, medicines, and equipment. In this regard, early graduations of fourth-year students from military medical academies and medical institutes were organized. Thanks to this, by the second year of the war, the army was provided with medical personnel in all specialties by an average of 95%. With the help of these people, soldiers and home front workers, mothers, children and the elderly received medical care. The chief surgeon of the Red Army was N. N. Burdenko, the chief surgeon of the Navy was Yu. Yu. Dzhanelidze. Also, many famous people worked at the fronts, who received awards for their activities, memory and glory after the war. Thanks to the coordinated actions of doctors, numerous evacuation hospitals were organized, specialized medical care was improved for soldiers wounded in the head, neck, stomach, chest, etc. Scientific work did not stop, which in the pre-war period led to the production of blood substitutes and the invention of methods for preserving and transfusing blood. All this later helped save thousands of lives. In the war years, penicillin was tested, domestic sulfonamides and antibiotics were invented, which were used to combat sepsis and heal purulent, difficult-to-heal wounds. The main successes of medicine in the postwar years include a thorough study of the sanitary situation and the effective elimination of problems in this area, as well as the opening of the first USSR Academy of Medical Sciences, whose president was N. N. Burdenko. This happened on June 30, 1944, before the end of the war. The USSR Academy of Medical Sciences is now called RAMS (Russian Academy of Medical Sciences), its research centers are located in many of the largest cities in Russia. In them, scientists are engaged in the study of issues in all areas of theoretical and practical medicine. Further from 1960 to 1990. Soviet medicine experienced successive periods of ups and downs. In the 1960s developed a new branch of medicine - space medicine. This was due to the development of cosmonautics, the first flight of Yu. A. Gagarin on April 12, 1961, and other events in this area. Also in the early 1960s. large hospitals (for 300-600 or more beds) began to be built throughout the country, the number of polyclinics grew, children's hospitals and sanatoriums were created, and new vaccines and drugs were introduced into practice. In therapy, separate specialties began to stand out and develop (cardiology, pulmonology, etc.). Surgery advanced by leaps and bounds, as the principles of microsurgery, transplantation and prosthetics of organs and tissues were developed. In 1965, the first successful living donor kidney transplant was performed. The operation was performed by Boris Vasilyevich Petrovsky. At the same time, research was carried out in the field of heart transplantation (artificial, and then animal). Here, Valery Ivanovich Shumakov, who was the first to perform such operations (first on a calf, and then on a man), should be especially singled out. In the field of medical education, reforms unfolded in 1967-1969: then a system of seven-year training of medical personnel was introduced. The system of improvement of doctors began to develop intensively. In the 1970s Russia was ahead of the whole world in terms of the number of doctors per 10 population. However, there was a problem of shortage of personnel with secondary medical education. Due to the lack of funding for secondary medical educational institutions, it was not possible to recruit the required number of personnel. In the mid 1970s. Diagnostic centers were actively opened and equipped, maternal and child health was improved, and much attention was paid to cardiovascular and oncological diseases. Despite all the achievements, by the end of the 1970s. Soviet medicine experienced a period of decline due to insufficient funding and underdevelopment of certain state health programs. In the 1980s continued to actively study the issues of cardiology, oncology, leukemia, implantation and prosthetics of organs. In 1986, the first successful heart transplant was performed. The author of the work was Valery Ivanovich Shumakov. The ambulance system was also actively developed, automated control systems "ambulance" and "hospital" were created. A grandiose task in the field of public health in 1983 was the universal, nationwide medical examination and specialized treatment of the population. It was not possible to carry it out to the end - there was neither a clear plan nor means for this. Thus, the main problem of health care at the end of the Soviet period was the discrepancy in the scope of the planned reforms. It was necessary to introduce new methods of financing, to attract private and state structures. Therefore, despite all the colossal scientific and practical work carried out, the government has not achieved the expected changes and results in terms of healthcare. This was partly due to the approaching collapse of the USSR and the weakening of the influence of power structures. Author: Bachilo E.V. << Back: Development of medicine in Russia in the second half of the 19th - early 20th centuries (General historical characteristics of the period under review. Development of therapy. Advanced features of domestic therapy in the second half of the 19th century. Surgery. Asepsis. Development of hygiene in Russia. Pediatrics. Pathological anatomy in Russia. The importance of zemstvo medicine in Russia for the development of medical science) >> Forward: Development of medicine at the end of the 20th century. International cooperation in the field of health (Development of healthcare at the end of the 20th - beginning of the 21st centuries. International cooperation in the field of healthcare. History, modern development)
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